Ede J, Pickworth H, Kent B, Watkinson P, Endacott R
Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom.
Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom.
Intensive Crit Care Nurs. 2025 Oct;90:104064. doi: 10.1016/j.iccn.2025.104064. Epub 2025 Jun 12.
To identify escalation success factors documented in care records of patients who triggered an Early Warning Score ≥ 7 in the ward, avoided an Intensive Care Unit admission and survived and compare these with ward patients who triggered an Early Warning Score ≥ 7, went to intensive care and died during their admission.
A multi-site, retrospective records review was conducted on 340 survivors and 50 non-survivors who were either admitted to, or who avoided intensive care.
Non-survivors of deterioration tended to be older, earlier into their hospital admission, and had a greater number of co-morbidities at the time of their trigger event. Overall, superior care was observed in non-survivors when triangulating quality of care scores and escalation care quality metrics (escalation compliance, hourly observations, and medical re-evaluation). Survivors avoided an Intensive Care Unit admission through responding to ward management or being referred to a specialist team. However, 9.7 % (33/340) of survivors were still triggering at the time of discharge, and 54 % of these had either Covid-19 or a long-term cardiorespiratory condition.
This study found differences in how clinical staff responded to patient deterioration between survivors and non-survivors. Although non-survivors received higher-rated care and met more escalation quality indicators, their poorer outcomes were likely influenced by more severe underlying conditions. Despite both patient groups having comparable scores, staff appeared to make nuanced judgments factoring in clinical concerns not captured by the score alone (success factor).
Despite generating the same warning score values, there is wide variation in true patient acuity that only clinical staff can discriminate, and escalation protocols alone may not be advanced enough to address this subtlety.
确定在病房中触发早期预警评分≥7、避免入住重症监护病房并存活的患者护理记录中记载的病情升级成功因素，并将这些因素与触发早期预警评分≥7、入住重症监护病房并在住院期间死亡的病房患者进行比较。
对340名幸存者和50名非幸存者进行了多中心回顾性记录审查，这些患者要么已入住重症监护病房，要么避免了入住重症监护病房。
病情恶化的非幸存者往往年龄较大，入院较早，在触发事件发生时合并症较多。总体而言，在对护理质量评分和病情升级护理质量指标（病情升级依从性、每小时观察和医疗重新评估）进行三角测量时，观察到非幸存者得到了更好的护理。幸存者通过响应病房管理或被转诊至专科团队而避免了入住重症监护病房。然而，9.7%（33/340）的幸存者在出院时仍有触发情况，其中54%患有新冠病毒病或长期心肺疾病。
本研究发现幸存者和非幸存者的临床工作人员在应对患者病情恶化方面存在差异。尽管非幸存者接受了更高评分的护理并符合更多病情升级质量指标，但他们较差的预后可能受到更严重基础疾病的影响。尽管两组患者的评分相当，但工作人员似乎做出了细微的判断，将仅靠评分无法体现的临床问题考虑在内（成功因素）。
尽管产生了相同的预警评分值，但真正的患者病情严重程度存在很大差异，只有临床工作人员能够辨别，仅靠病情升级方案可能不足以应对这种细微差别。
